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ʋ4x2007 iɬɨɦ 15
ȺȺ. ɅɕɁɂɄɈȼ, ȺȺ. ɉȿɑȿɇɄɂɇ, ȼɋ. ɋȿȾȿɅɖɇɂɄ, ȼ. ȼɅȺȼɈɑɄɂɇ
ÎÏÒÈÌÈÇÀÖÈß ÊÎÌÁÈÍÈÐÎÂÀÍÍÎÃÎ ËÅ×ÅÍÈß ÒÐÎÔÈ×ÅÑÊÈÕ
ÍÀÐÓØÅÍÈÉ ÂÀÐÈÊÎÇÍÎÉ ÝÒÈÎËÎÃÈÈ
ɍɈ «Ƚɨɦɟɥɶɫɤɢɣɝɨɫɭɞɚɪɫɬɜɟɧɧɵɣɦɟɞɢɰɢɧɫɤɢɣɭɧɢɜɟɪɫɢɬɟɬ»,
ɍɁ « Ƚɨɦɟɥɶɫɤɢɣɤɥɢɧɢɱɟɫɤɢɣɤɚɪɞɢɨɥɨɝɢɱɟɫɤɢɣɞɢɫɩɚɧɫɟɪ»,
ɊɟɫɩɭɛɥɢɤɚȻɟɥɚɪɭɫɶ
ȼ ɫɬɚɬɶɟ ɩɪɟɞɫɬɚɜɥɟɧɵ ɪɟɡɭɥɶɬɚɬɵ ɤɨɦɛɢɧɢɪɨɜɚɧɧɨɝɨ ɥɟɱɟɧɢɹ ɬɪɨɮɢɱɟɫɤɢɯ ɹɡɜ ɩɪɢ ɞɟɤɨɦɩɟɧɫɢɪɨɜɚɧɧɨɣɯɪɨɧɢɱɟɫɤɨɣɜɟɧɨɡɧɨɣɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ. Ȼɵɥɚɢɡɭɱɟɧɚ ɝɪɭɩɩɚɢɡ 187 ɛɨɥɶɧɵɯ, ɧɚɯɨɞɢɜɲɢɯɫɹɧɚɥɟɱɟɧɢɢɜȽɨɦɟɥɶɫɤɨɦɨɛɥɚɫɬɧɨɦɨɬɞɟɥɟɧɢɢɯɢɪɭɪɝɢɢɫɨɫɭɞɨɜɜ 2001-2005
ɝɨɞɚɯ. ɉɪɨɚɧɚɥɢɡɢɪɨɜɚɧɵɪɟɡɭɥɶɬɚɬɵɯɢɪɭɪɝɢɱɟɫɤɨɝɨ, ɤɨɧɫɟɪɜɚɬɢɜɧɨɝɨɢɤɨɦɛɢɧɢɪɨɜɚɧɧɨɝɨɥɟɱɟɧɢɹ. ȼɫɟɦ ɛɨɥɶɧɵɦ ɜɵɩɨɥɧɹɥɫɹ ɩɨɫɟɜ ɫɨɞɧɚ ɹɡɜɟɧɧɨɝɨ ɞɟɮɟɤɬɚ ɧɚ ɦɢɤɪɨɮɥɨɪɭ ɢ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ ɤ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɵɦ ɩɪɟɩɚɪɚɬɚɦ. ɉɨ ɞɚɧɧɵɦ ɦɢɤɪɨɛɢɨɥɨɝɢɱɟɫɤɨɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ,
ɡɨɥɨɬɢɫɬɵɣɫɬɚɮɢɥɨɤɨɤɤɜɫɬɪɟɱɚɥɫɹɭ 163 (87,3%) ɩɚɰɢɟɧɬɨɜ, ɫɬɪɟɩɬɨɤɨɤɤ ɭ 65 (34,6%) ɛɨɥɶɧɵɯ.
Ⱦɪɭɝɢɟɦɢɤɪɨɨɪɝɚɧɢɡɦɵ, ɬɚɤɢɟ, ɤɚɤɫɢɧɟɝɧɨɣɧɚɹɩɚɥɨɱɤɚɢɩɪɨɬɟɣ, ɜɵɞɟɥɹɥɢɫɶɪɟɞɤɨ (ɞɨ 1,6 %).
ɋɪɨɤɢɡɚɠɢɜɥɟɧɢɹɹɡɜɭɩɚɰɢɟɧɬɨɜɩɨɫɥɟɨɩɟɪɚɬɢɜɧɨɝɨɥɟɱɟɧɢɹɫɨɫɬɚɜɢɥɢ 12±1,2 ɧɟɞɟɥɢ, ɭɛɨɥɶɧɵɯ, ɤɨɬɨɪɵɦɩɪɨɜɨɞɢɥɨɫɶɥɢɲɶɤɨɧɫɟɪɜɚɬɢɜɧɚɹɬɟɪɚɩɢɹ, – 60±1,1 ɧɟɞɟɥɢ. Ɉɩɪɟɞɟɥɟɧɚɥɝɨɪɢɬɦ
ɤɨɦɛɢɧɢɪɨɜɚɧɧɨɝɨɤɨɦɩɥɟɤɫɧɨɝɨɥɟɱɟɧɢɹɬɪɨɮɢɱɟɫɤɢɯɹɡɜɩɪɢɞɟɤɨɦɩɟɧɫɢɪɨɜɚɧɧɨɣɯɪɨɧɢɱɟɫɤɨɣ
ɜɟɧɨɡɧɨɣɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ.
Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ: ɯɪɨɧɢɱɟɫɤɚɹ ɜɟɧɨɡɧɚɹ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶ, ɤɨɦɛɢɧɢɪɨɜɚɧɧɨɟ ɥɟɱɟɧɢɟ,
ɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɹ, ɦɢɤɪɨɮɥɨɪɚ.
The results of trophic ulcers combined treatment in case of chronic venous insufficiency are
presented in the report. 187 patients with terminal chronic venous insufficiency admitted to Gomel region
vascular surgery department in 2001-2005 were studied. The results of surgical, conservative and combined
treatment were analyzed. Microbiological study of ulcer content was performed in all patients and
antibacterial medicines resistance was revealed. Incidence of staphylococcus aureus was detected in
163 patients (87, 3%) and streptococcus aerugenosa - in 65 (34, 6% cases). Appearance of other
microorganisms such as proteus vulgaris etc. was rare (up to 1, 6 %). The terms of ulcer healing in the
patients after surgical treatment were 12±1, 2 weeks and in the patients who received conservative
therapy - 60±1, 1 week. Management order of terminal chronic venous insufficiency combined complex
treatment has been determined.
Keywords: chronic venous insufficiency, antibiotic therapy, microorganisms, combined
treatment.
Ɂɚɛɨɥɟɜɚɧɢɹɜɟɧɧɢɠɧɢɯɤɨɧɟɱɧɨɫɬɟɣ,
ɚɢɦɟɧɧɨɩɟɪɜɢɱɧɚɹɜɚɪɢɤɨɡɧɚɹɛɨɥɟɡɧɶɢ
ɟɟɨɫɥɨɠɧɟɧɢɹ, ɱɪɟɡɜɵɱɚɣɧɨɲɢɪɨɤɨɪɚɫɩɪɨɫɬɪɚɧɟɧɵɜɧɚɲɟɦɪɟɝɢɨɧɟ. ɉɟɪɜɢɱɧɨɣ
ɜɚɪɢɤɨɡɧɨɣɛɨɥɟɡɧɶɸ, ɤɥɢɧɢɱɟɫɤɢɦɢɩɪɢɡɧɚɤɚɦɢɤɨɬɨɪɨɣɹɜɥɹɟɬɫɹ ɪɚɫɲɢɪɟɧɢɟɩɨɞɤɨɠɧɵɯɜɟɧɧɢɠɧɢɯɤɨɧɟɱɧɨɫɬɟɣɫɪɚɡɥɢɱɧɵɦɢ ɩɪɨɹɜɥɟɧɢɹɦɢ ɯɪɨɧɢɱɟɫɤɨɣ ɜɟɧɨɡ-
ɧɨɣɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ (ɏȼɇ) [1, 2], ɫɬɪɚɞɚɟɬ ɩɪɢɦɟɪɧɨ 17-25% ɧɚɫɟɥɟɧɢɹ. Ɉɫɨɛɭɸ
ɫɨɰɢɚɥɶɧɭɸɢ ɷɤɨɧɨɦɢɱɟɫɤɭɸɡɧɚɱɢɦɨɫɬɶ
ɢɦɟɟɬ ɯɪɨɧɢɱɟɫɤɚɹ ɜɟɧɨɡɧɚɹ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶ III ɫɬɟɩɟɧɢ, ɬɚɤɤɚɤ ɪɚɡɜɢɜɚɟɬɫɹɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨɜɬɪɭɞɨɫɩɨɫɨɛɧɨɦɜɨɡɪɚɫɬɟɢ
ɹɜɥɹɟɬɫɹɩɪɢɱɢɧɨɣɞɥɢɬɟɥɶɧɨɣɜɪɟɦɟɧɧɨɣ
ɧɟɬɪɭɞɨɫɩɨɫɨɛɧɨɫɬɢɢɢɧɜɚɥɢɞɧɨɫɬɢ [5].
81
”ɇɨɜɨɫɬɢɯɢɪɭɪɝɢɢ
ȼ ɛɨɥɶɲɢɧɫɬɜɟ ɫɥɭɱɚɟɜ ɯɪɨɧɢɱɟɫɤɭɸ
ɜɟɧɨɡɧɭɸɧɟɩɪɨɯɨɞɢɦɨɫɬɶɨɛɭɫɥɨɜɥɢɜɚɸɬ
ɨɫɬɪɵɟ ɬɪɨɦɛɨɮɥɟɛɢɬɵ ɤɚɤ ɨɫɥɨɠɧɟɧɢɟ
ɜɚɪɢɤɨɡɧɨɣɛɨɥɟɡɧɢ. Ɉɧɢɩɟɪɟɯɨɞɹɬɜɫɜɨɸ
ɞɚɥɶɧɟɣɲɭɸɫɬɚɞɢɸɪɚɡɜɢɬɢɹɢɥɢɫɬɚɞɢɸ
ɨɫɥɨɠɧɟɧɢɣ, ɜɵɡɵɜɚɹɯɪɨɧɢɱɟɫɤɭɸɧɟɩɪɨɯɨɞɢɦɨɫɬɶɦɚɝɢɫɬɪɚɥɶɧɵɯɜɟɧɫɨɛɪɚɡɨɜɚɧɢɟɦ ɬɚɤ ɧɚɡɵɜɚɟɦɨɣ ɯɪɨɧɢɱɟɫɤɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢɢɪɚɡɜɢɬɢɟɦɉɌɎȻ [6, 7].
ɏɨɪɨɲɨ ɢɡɜɟɫɬɧɨ, ɱɬɨ ɜ ɧɨɪɦɚɥɶɧɵɯ
ɭɫɥɨɜɢɹɯɨɫɧɨɜɧɨɣɨɬɬɨɤɜɟɧɨɡɧɨɣɤɪɨɜɢ
(85-90%) ɩɪɨɢɫɯɨɞɢɬɱɟɪɟɡɝɥɭɛɨɤɢɟɜɟɧɵ
ɧɢɠɧɟɣɤɨɧɟɱɧɨɫɬɢ [5]. ɑɚɫɬɶɤɪɨɜɢɜɝɥɭɛɨɤɭɸɜɟɧɨɡɧɭɸɫɢɫɬɟɦɭɩɨɫɬɭɩɚɟɬɢɡɩɨɞɤɨɠɧɵɯ ɱɟɪɟɡ ɩɟɪɮɨɪɚɧɬɧɵɟ ɜɟɧɵ. Ɉɧɢ
ɢɦɟɸɬɤɥɚɩɚɧɵ, ɱɚɫɬɨɨɞɢɧɨɱɧɵɟ, ɪɚɫɩɨɥɨɠɟɧɧɵɟɤɚɤɪɚɡɧɚɦɟɫɬɟɜɩɚɞɟɧɢɹɩɟɪɮɨɪɚɧɬɧɨɣɜɝɥɭɛɨɤɭɸɜɟɧɭ. ɉɪɢɜɨɡɧɢɤɧɨɜɟɧɢɢɨɫɬɪɨɝɨɬɪɨɦɛɨɡɚɭɱɚɫɬɤɚɝɥɭɛɨɤɨɣ
ɜɟɧɨɡɧɨɣɫɢɫɬɟɦɵɨɬɬɨɤɤɪɨɜɢɢɡɩɨɪɚɠɟɧɧɨɣɤɨɧɟɱɧɨɫɬɢɝɪɭɛɨɢɡɜɪɚɳɚɟɬɫɹ. ȼɜɢɞɭ
ɬɨɝɨ, ɱɬɨɨɧɭɠɟɧɟɦɨɠɟɬɨɫɭɳɟɫɬɜɥɹɬɶɫɹ
ɱɟɪɟɡɝɥɭɛɨɤɢɟɜɟɧɵ, ɜɫɹɦɚɫɫɚɤɪɨɜɢɭɫɬɪɟɦɥɹɟɬɫɹɱɟɪɟɡɩɟɪɮɨɪɚɧɬɧɵɟɜɟɧɵɜɨɛɪɚɬɧɨɦɧɚɩɪɚɜɥɟɧɢɢɜɩɨɜɟɪɯɧɨɫɬɧɭɸɜɟɧɨɡɧɭɸɫɟɬɶ. ɉɪɢɷɬɨɦɩɨɞɧɚɩɨɪɨɦɤɪɨɜɢ
ɩɪɨɢɫɯɨɞɢɬ ɪɚɫɲɢɪɟɧɢɟ ɩɪɨɫɜɟɬɚ ɩɟɪɮɨɪɚɧɬɧɵɯɢɩɨɞɤɨɠɧɵɯɜɟɧ, ɢɯɤɥɚɩɚɧɧɵɣ
ɚɩɩɚɪɚɬ, ɯɨɬɹɚɧɚɬɨɦɢɱɟɫɤɢɟɳɟɫɨɯɪɚɧɹɟɬɫɹ, ɮɭɧɤɰɢɨɧɚɥɶɧɨ ɫɬɚɧɨɜɢɬɫɹ ɧɟɞɟɟɫɩɨɫɨɛɧɵɦ. ɋɬɟɧɤɢɩɨɞɤɨɠɧɵɯɜɟɧɝɢɩɟɪɬɪɨɮɢɪɭɸɬɫɹ, ɧɨ ɫɨɯɪɚɧɹɸɬ ɫɜɨɸ ɩɪɹɦɨɥɢɧɟɣɧɨɫɬɶɢɨɫɭɳɟɫɬɜɥɹɸɬɤɨɦɩɟɧɫɚɬɨɪɧɭɸ
ɪɨɥɶɩɨɪɚɡɝɪɭɡɤɟɤɨɧɟɱɧɨɫɬɢɨɬɜɟɧɨɡɧɨɣ
ɤɪɨɜɢ [8]. ȼɞɚɥɶɧɟɣɲɟɦ, ɢɫɩɵɬɵɜɚɹɩɨɫɬɨɹɧɧɨɟɜɵɫɨɤɨɟɞɚɜɥɟɧɢɟ, ɫɬɟɧɤɢɩɨɞɤɨɠɧɵɯ
ɜɟɧɢɫɬɨɧɱɚɸɬɫɹ, ɦɵɲɟɱɧɵɟɜɨɥɨɤɧɚɡɚɦɟɧɹɸɬɫɹɫɨɟɞɢɧɢɬɟɥɶɧɨɬɤɚɧɧɵɦɢɢɧɚɱɢɧɚɟɬɫɹɫɟɝɦɟɧɬɚɪɧɨɟɜɚɪɢɤɨɡɧɨɟɪɚɫɲɢɪɟɧɢɟ
ɩɨɞɤɨɠɧɨɣ ɜɟɧɨɡɧɨɣ ɫɟɬɢ, ɨɞɧɨɜɪɟɦɟɧɧɨ
ɩɪɨɢɫɯɨɞɢɬɢɪɚɡɪɭɲɟɧɢɟɤɥɚɩɚɧɧɨɝɨɚɩɩɚɪɚɬɚ. ȼ ɫɜɨɸ ɨɱɟɪɟɞɶ ɬɪɨɦɛɨɬɢɱɟɫɤɢɟ
ɦɚɫɫɵ ɜ ɝɥɭɛɨɤɢɯ ɜɟɧɚɯ ɧɚɱɢɧɚɸɬ ɬɚɤɠɟ
ɩɨɞɜɟɪɝɚɬɶɫɹɢɡɦɟɧɟɧɢɹɦ: ɨɧɢɦɨɝɭɬɥɢɛɨ
ɨɪɝɚɧɢɡɨɜɚɬɶɫɹ ɫ ɩɪɨɪɚɫɬɚɧɢɟɦ ɫɨɟɞɢɧɢ82
ɬɟɥɶɧɨɣɬɤɚɧɶɸ, ɥɢɛɨɪɟɞɤɨɩɨɞɜɟɪɝɚɸɬɫɹ
ɫɟɩɬɢɱɟɫɤɨɦɭɪɚɫɩɥɚɜɥɟɧɢɸ, ɨɞɧɚɤɨɱɚɳɟ
ɜɫɟɝɨɩɨɞɜɟɪɝɚɸɬɫɹɪɟɤɚɧɚɥɢɡɚɰɢɢ [9, 10].
ɂ ɱɟɦ ɜɵɪɚɠɟɧɧɟɟ ɪɟɤɚɧɚɥɢɡɚɰɢɹ, ɬɟɦ
ɛɨɥɶɲɟ ɪɚɡɪɭɲɟɧɢɹ ɤɥɚɩɚɧɧɨɝɨ ɚɩɩɚɪɚɬɚ
ɝɥɭɛɨɤɢɯɢɩɟɪɮɨɪɚɧɬɧɵɯɜɟɧ. ɉɪɢɜɵɪɚɠɟɧɧɨɣ ɪɟɤɚɧɚɥɢɡɚɰɢɢ ɝɥɭɛɨɤɢɟ ɜɟɧɵ
ɩɪɟɞɫɬɚɜɥɹɸɬɫɹ ɪɢɝɢɞɧɵɦɢ ɫɤɥɟɪɨɡɢɪɨɜɚɧɧɵɦɢɬɪɭɛɤɚɦɢ, ɥɢɲɟɧɧɵɦɢɤɥɚɩɚɧɧɨɝɨɚɩɩɚɪɚɬɚ. ȼɷɬɨɬɩɟɪɢɨɞɜɚɪɢɤɨɡɧɨɝɨɪɚɫɲɢɪɟɧɢɹɩɨɞɤɨɠɧɵɯɜɟɧɪɚɡɪɭɲɟɧɢɹɤɥɚɩɚɧɧɨɝɨ ɚɩɩɚɪɚɬɚɢ ɪɟɤɚɧɚɥɢɡɚɰɢɢɬɪɨɦɛɨɜ ɩɪɨɢɫɯɨɞɢɬ ɧɚɢɛɨɥɶɲɟɟ ɢɡɜɪɚɳɟɧɢɟ
ɤɪɨɜɨɬɨɤɚ [11, 12]. ɍ ɪɹɞɚɛɨɥɶɧɵɯɜɚɪɢɤɨɡɧɨɢɡɦɟɧɟɧɧɵɟɩɨɞɤɨɠɧɵɟɜɟɧɵɫɪɚɡɪɭɲɟɧɧɵɦ ɤɥɚɩɚɧɧɵɦ ɚɩɩɚɪɚɬɨɦ ɬɨɥɶɤɨ
ɭɫɭɝɭɛɥɹɸɬɹɜɥɟɧɢɹɜɟɧɨɡɧɨɝɨɡɚɫɬɨɹ. Ɉɧɢ
ɩɨɥɧɨɫɬɶɸɬɟɪɹɸɬɫɜɨɸɤɨɦɩɟɧɫɚɬɨɪɧɭɸ
ɪɨɥɶ, ɫɨɡɞɚɸɬ ɩɨɪɨɱɧɵɣ ɤɪɭɝ, ɭɫɭɝɭɛɥɹɸɳɢɣ ɯɪɨɧɢɱɟɫɤɭɸ ɜɟɧɨɡɧɭɸ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶɤɨɧɟɱɧɨɫɬɢ [13]. ɂ, ɧɟɫɦɨɬɪɹɧɚɬɨ,
ɱɬɨɪɟɤɚɧɚɥɢɡɨɜɚɧɧɵɟɝɥɭɛɨɤɢɟɜɟɧɵɬɚɤɠɟɥɢɲɟɧɵɤɥɚɩɚɧɧɨɝɨɚɩɩɚɪɚɬɚɢɮɭɧɤɰɢɨɧɢɪɭɸɬɤɚɤɩɨɥɵɟɪɢɝɢɞɧɵɟɬɪɭɛɤɢ, ɧɚɩɪɚɜɥɟɧɢɟɨɫɧɨɜɧɨɝɨɤɪɨɜɨɬɨɤɚɱɟɪɟɡɧɢɯ,
ɫɨɡɞɚɜɚɟɦɨɝɨɞɚɠɟɢɫɤɭɫɫɬɜɟɧɧɵɦ, ɨɩɟɪɚɬɢɜɧɵɦɩɭɬɟɦ, ɡɧɚɱɢɬɟɥɶɧɨɭɦɟɧɶɲɚɟɬɹɜɥɟɧɢɹɜɟɧɨɡɧɨɣɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢɤɨɧɟɱɧɨɫɬɢ, ɜɤɚɤɨɣɬɨɫɬɟɩɟɧɢɩɪɢɛɥɢɠɚɟɬɜɟɧɨɡɧɵɣɤɪɨɜɨɬɨɤɤ «ɮɢɡɢɨɥɨɝɢɱɟɫɤɨɦɭ».
ȼɟɧɨɡɧɵɟɹɡɜɵɯɚɪɚɤɬɟɪɢɡɭɸɬɫɹɞɟɝɟɧɟɪɚɰɢɟɣɬɤɚɧɟɣɢɛɚɤɬɟɪɢɚɥɶɧɨɣ ɢɧɮɟɤɰɢɟɣ, ɱɬɨɨɛɭɫɥɚɜɥɢɜɚɟɬɞɜɚɨɫɧɨɜɧɵɯɧɚɩɪɚɜɥɟɧɢɹɩɚɬɨɝɟɧɟɬɢɱɟɫɤɨɝɨɥɟɱɟɧɢɹ [14,
15]. ɇɚɥɢɱɢɟ ɜɟɧɨɡɧɨɝɨ ɫɛɪɨɫɚ ɤɪɨɜɢ ɢɡ
ɝɥɭɛɨɤɢɯɜɟɧɜɩɨɜɟɪɯɧɨɫɬɧɵɟɜɟɞɟɬɤɩɨɜɵɲɟɧɢɸɜɩɨɫɥɟɞɧɢɯɝɢɞɪɨɫɬɚɬɢɱɟɫɤɨɝɨ
ɞɚɜɥɟɧɢɹ, ɱɬɨ, ɜɫɜɨɸɨɱɟɪɟɞɶ, ɩɪɢɜɨɞɢɬɤ
ɩɪɨɩɨɬɟɜɚɧɢɸɤɪɨɜɢɜɨɤɪɭɠɚɸɳɢɟɬɤɚɧɢ
ɢ ɨɛɪɚɡɨɜɚɧɢɸ ɬɪɨɮɢɱɟɫɤɢɯ ɧɚɪɭɲɟɧɢɣ
ɤɨɠɧɵɯɩɨɤɪɨɜɨɜ. ɉɪɢɪɚɡɜɢɬɢɢɬɪɨɮɢɱɟɫɤɢɯɢɡɦɟɧɟɧɢɣɭɤɨɠɢɫɧɢɠɚɸɬɫɹ ɡɚɳɢɬɧɵɟɫɜɨɣɫɬɜɚ, ɱɬɨɫɭɳɟɫɬɜɟɧɧɨɨɛɥɟɝɱɚɟɬ
ɩɪɢɫɨɟɞɢɧɟɧɢɟɢɪɚɡɜɢɬɢɟɢɧɮɟɤɰɢɢ. ɇɚɥɢɱɢɟ ɢɧɮɟɤɰɢɨɧɧɨɝɨ ɚɝɟɧɬɚ ɭɫɢɥɢɜɚɟɬ
ʋ4x2007 iɬɨɦ 15
ɬɪɨɮɢɱɟɫɤɢɟɧɚɪɭɲɟɧɢɹɢ «ɩɨɪɨɱɧɵɣɤɪɭɝ»
ɡɚɦɵɤɚɟɬɫɹ [15]. ɂɫɯɨɞɹɢɡɷɬɨɝɨ, ɢɡɭɱɟɧɢɟ
ɫɨɫɬɚɜɚɦɢɤɪɨɮɥɨɪɵɢɟɟɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɢɤɚɧɬɢɛɢɨɬɢɤɚɦɧɟɨɛɯɨɞɢɦɨɞɥɹɛɵɫɬɪɟɣɲɟɝɨɩɨɥɭɱɟɧɢɹɯɨɪɨɲɟɝɨɷɮɮɟɤɬɚɢɫɨɤɪɚɳɟɧɢɹɫɪɨɤɨɜɥɟɱɟɧɢɹ.
ɐɟɥɶɸ ɪɚɛɨɬɵ ɹɜɥɹɥɨɫɶ ɨɩɪɟɞɟɥɟɧɢɟ
ɨɩɬɢɦɚɥɶɧɨɣ ɬɚɤɬɢɤɢɥɟɱɟɧɢɹ ɛɨɥɶɧɵɯ ɫ
ɬɪɨɮɢɱɟɫɤɢɦɢɹɡɜɚɦɢɜɟɧɨɡɧɨɣɷɬɢɨɥɨɝɢɢ.
Ɂɚɞɚɱɢɢɫɫɥɟɞɨɜɚɧɢɹ:
1. ɂɡɭɱɢɬɶɫɨɫɬɚɜɦɢɤɪɨɮɥɨɪɵɬɪɨɮɢɱɟɫɤɢɯɯɪɨɧɢɱɟɫɤɢɯɜɟɧɨɡɧɵɯɹɡɜ.
2. Ɉɩɪɟɞɟɥɢɬɶ ɫɩɟɤɬɪ ɭɫɬɨɣɱɢɜɨɫɬɢ
ɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜ ɤ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɵɦ
ɩɪɟɩɚɪɚɬɚɦ.
3. ɉɪɨɚɧɚɥɢɡɢɪɨɜɚɬɶɪɟɡɭɥɶɬɚɬɵɥɟɱɟɧɢɹ ɩɚɰɢɟɧɬɨɜ ɫ ɯɪɨɧɢɱɟɫɤɨɣ ɜɟɧɨɡɧɨɣ
ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶɸɫɭɱɟɬɨɦɭɫɬɨɣɱɢɜɨɫɬɢ
ɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜɤɚɧɬɢɛɢɨɬɢɤɚɦ.
4. ɉɪɨɚɧɚɥɢɡɢɪɨɜɚɬɶɪɟɡɭɥɶɬɚɬɵɯɢɪɭɪɝɢɱɟɫɤɨɝɨɥɟɱɟɧɢɹ.
5. Ɉɩɪɟɞɟɥɢɬɶɨɩɬɢɦɚɥɶɧɨɟɤɨɦɩɥɟɤɫɧɨɟɥɟɱɟɧɢɟɬɚɤɢɯɛɨɥɶɧɵɯ.
Ɇɚɬɟɪɢɚɥɵɢɦɟɬɨɞɵ
Ȼɵɥɚɢɡɭɱɟɧɚɝɪɭɩɩɚɢɡ 187 ɛɨɥɶɧɵɯɫ
ɞɟɤɨɦɩɟɧɫɢɪɨɜɚɧɧɨɣ ɮɨɪɦɨɣ ɩɟɪɜɢɱɧɨɣ
ɜɚɪɢɤɨɡɧɨɣɛɨɥɟɡɧɢ (ɨɬɤɪɵɬɨɣɬɪɨɮɢɱɟɫɤɨɣɹɡɜɨɣ) ɜɜɨɡɪɚɫɬɟ 62,3±7,1 ɥɟɬ, ɧɚɯɨɞɢɜɲɢɯɫɹɧɚɥɟɱɟɧɢɢɜȽɨɦɟɥɶɫɤɨɦɨɛɥɚɫɬɧɨɦ
ɨɬɞɟɥɟɧɢɢ ɯɢɪɭɪɝɢɢ ɫɨɫɭɞɨɜ ɜ 2001-2005
ɝɨɞɚɯ. ȼɢɫɫɥɟɞɨɜɚɧɢɟɜɤɥɸɱɚɥɢɫɶɩɚɰɢɟɧɬɵɫɩɥɨɳɚɞɶɸɬɪɨɮɢɱɟɫɤɨɣɹɡɜɵɛɨɥɟɟ 1%
ɩɨɜɟɪɯɧɨɫɬɢɬɟɥɚ, ɱɬɨ ɹɜɢɥɨɫɶ ɩɪɢɱɢɧɨɣ
ɞɥɢɬɟɥɶɧɵɯɫɪɨɤɨɜɥɟɱɟɧɢɹ. ɉɨɞɞɥɢɬɟɥɶɧɨɫɬɶɸ ɥɟɱɟɧɢɹɩɨɧɢɦɚɥɢ ɩɟɪɢɨɞɨɬ ɦɨɦɟɧɬɚɜɵɹɜɥɟɧɢɹɬɪɨɮɢɱɟɫɤɨɣɹɡɜɵɞɨɦɨɦɟɧɬɚɟɺɷɩɢɬɟɥɢɡɚɰɢɢ. ȼɫɟɛɨɥɶɧɵɟɢɦɟɥɢ III ɫɬɟɩɟɧɶɯɪɨɧɢɱɟɫɤɨɣɜɟɧɨɡɧɨɣɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ [7].
ȼɫɟɦɩɚɰɢɟɧɬɚɦɩɪɨɜɨɞɢɥɨɫɶɤɨɦɩɥɟɤɫɧɨɟ ɥɟɱɟɧɢɟ ɯɪɨɧɢɱɟɫɤɨɣ ɜɟɧɨɡɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ, ɜɤɥɸɱɚɸɳɟɟɤɨɦɩɪɟɫɫɢɨɧɧɭɸ ɬɟɪɚɩɢɸ, ɨɩɟɪɚɬɢɜɧɨɟ ɥɟɱɟɧɢɟ (ɩɨ
ɩɨɤɚɡɚɧɢɹɦ), ɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɸ, ɬɟɪɚɩɢɸ, ɭɥɭɱɲɚɸɳɭɸɦɢɤɪɨɰɢɪɤɭɥɹɰɢɸɢɪɟɨɥɨɝɢɱɟɫɤɢɟɫɜɨɣɫɬɜɚɤɪɨɜɢ, ɚɬɚɤɠɟɥɚɡɟɪɨɬɟɪɚɩɢɸ [3,4]. ȼɫɟɦɛɨɥɶɧɵɦɩɪɨɢɡɜɨɞɢɥɢɫɶɤɥɢɧɢɱɟɫɤɢɟ, ɮɭɧɤɰɢɨɧɚɥɶɧɵɟɢ
ɭɥɶɬɪɚɡɜɭɤɨɜɵɟɢɫɫɥɟɞɨɜɚɧɢɹɜɟɧɧɢɠɧɢɯ
ɤɨɧɟɱɧɨɫɬɟɣ.
ɉɪɢɫɬɚɬɢɫɬɢɱɟɫɤɨɣɨɛɪɚɛɨɬɤɟɩɨɥɶɡɨɜɚɥɢɫɶɩɪɨɝɪɚɦɦɨɣ Statistica 6.0 (Statsoft, USA)
ɫɩɪɢɦɟɧɟɧɢɟɦɤɪɢɬɟɪɢɹɋɬɶɸɞɟɧɬɚɢF2.
Ɋɟɡɭɥɶɬɚɬɵɢɨɛɫɭɠɞɟɧɢɟ
ɍ ɜɫɟɯ ɩɚɰɢɟɧɬɨɜ, ɧɚɯɨɞɢɜɲɢɯɫɹ ɧɚ
ɥɟɱɟɧɢɢɜɨɬɞɟɥɟɧɢɢɫɨɫɭɞɢɫɬɨɣɯɢɪɭɪɝɢɢ,
ɹɡɜɟɧɧɵɟɞɟɮɟɤɬɵɧɚɤɨɠɟɝɨɥɟɧɢɢɥɢɫɬɨɩɵɫɭɳɟɫɬɜɨɜɚɥɢɛɨɥɟɟɨɞɧɨɝɨɝɨɞɚɛɟɡɩɟɪɢɨɞɨɜɡɚɠɢɜɥɟɧɢɹ. ɍ 37 ɛɨɥɶɧɵɯ (20%) ɜ
ɚɧɚɦɧɟɡɟɛɵɥɨɪɨɠɢɫɬɨɟɜɨɫɩɚɥɟɧɢɟ, ɤɨɬɨɪɨɟɜɨɡɧɢɤɚɥɨɜɩɟɪɢɨɞɨɬɤɪɵɬɨɣɜɟɧɨɡɧɨɣ
ɬɪɨɮɢɱɟɫɤɨɣɹɡɜɵ. ɂɡɜɫɟɯɩɚɰɢɟɧɬɨɜ, ɤɨɬɨɪɵɟ ɩɟɪɟɧɟɫɥɢ ɪɨɠɢɫɬɨɟ ɜɨɫɩɚɥɟɧɢɟ,
ɪɟɰɢɞɢɜɢɪɭɸɳɟɟɬɟɱɟɧɢɟɧɚɛɥɸɞɚɥɨɫɶɭ 28
ɱɟɥɨɜɟɤ (76%). ɑɚɫɬɨɬɚɪɟɰɢɞɢɜɢɪɭɸɳɟɝɨ
ɪɨɠɢɫɬɨɝɨɜɨɫɩɚɥɟɧɢɹɜɩɟɪɢɨɞɨɬɤɪɵɬɨɣ
ɹɡɜɵɫɨɫɬɚɜɢɥɚ 2,2 ɪɚɡɚɜɝɨɞ.
ɍ 49 ɩɚɰɢɟɧɬɨɜ (26%) ɢɦɟɥɢɫɶɰɢɪɤɭɥɹɪɧɵɟɹɡɜɟɧɧɵɟɞɟɮɟɤɬɵɧɚɝɨɥɟɧɢɥɢɛɨ
ɫɢɥɶɧɨɜɵɪɚɠɟɧɧɵɟɢɧɞɭɪɚɰɢɹɢɥɢɩɨɞɟɪɦɚɬɨɫɤɥɟɪɨɡ. ɇɚɥɢɱɢɟɩɨɫɥɟɞɧɢɯɹɜɥɹɥɨɫɶ
ɩɪɨɬɢɜɨɩɨɤɚɡɚɧɢɟɦ ɤ ɜɵɩɨɥɧɟɧɢɸ ɪɚɞɢɤɚɥɶɧɨɣ ɮɥɟɛɷɤɬɨɦɢɢ ɫ ɫɭɛɮɚɫɰɢɚɥɶɧɨɣ
ɩɟɪɟɜɹɡɤɨɣɩɟɪɮɨɪɚɧɬɧɵɯɜɟɧɩɨɅɢɧɬɨɧɭ.
Ɉɫɬɚɥɶɧɵɦ 138 ɛɨɥɶɧɵɦɛɵɥɚɜɵɩɨɥɧɟɧɚ
ɨɩɟɪɚɰɢɹɅɢɧɬɨɧɚ.
ɉɪɨɚɧɚɥɢɡɢɪɨɜɚɜ ɢɫɯɨɞɵ ɨɩɟɪɚɬɢɜɧɨɝɨ ɥɟɱɟɧɢɹ, ɦɵ ɩɨɥɭɱɢɥɢ ɫɥɟɞɭɸɳɢɟ
ɪɟɡɭɥɶɬɚɬɵ:
- ɞɨɨɩɟɪɚɰɢɢɨɬɟɤɢɧɨɝɧɚɛɥɸɞɚɥɢɫɶ
ɭ 100%, ɚɩɨɫɥɟ – ɩɪɚɤɬɢɱɟɫɤɢɩɨɥɧɨɟɢɫɱɟɡɧɨɜɟɧɢɟɨɬɟɱɧɨɫɬɢɭ 47,9%, ɡɧɚɱɢɬɟɥɶɧɨɟ ɫɧɢɠɟɧɢɟ ɭ 25,5% ɢ ɧɟɡɧɚɱɢɬɟɥɶɧɨɟ
ɭɦɟɧɶɲɟɧɢɟɭ 26,5%;
- ɞɨ ɨɩɟɪɚɰɢɢ ɝɢɩɟɪɩɢɝɦɟɧɬɚɰɢɹ ɜɵɹɜɥɟɧɚɭ 93,8%, ɚɩɨɫɥɟ – ɩɨɥɧɨɟɢɫɱɟɡɧɨ83
”ɇɨɜɨɫɬɢɯɢɪɭɪɝɢɢ
Ɍɚɛɥɢɰɚ 1
ɑɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜɤɚɧɬɢɛɢɨɬɢɤɚɦ
ɱɭɜɫɬɜɢɬɟɥɟɧ
ɐɟɮɚɥɟɤɫɢɧ
ɉɟɧɢɰɢɥɥɢɧ
ɐɢɩɪɨɛɚɣ
Ƚɟɧɬɚɦɢɰɢɧ
Ɉɤɫɚɰɢɥɥɢɧ
ɗɪɢɬɪɨɦɢɰɢɧ
Ʌɢɧɤɨɦɢɰɢɧ
Ʉɥɢɧɞɚɦɢɰɢɧ
ɫɥɚɛɨ
ɱɭɜɫɬɜɢɬɟɥɟɧ
68,8%
52,8%
13,7%
27.7%
68,2%
3,8%
19,3%
8,8%
86,3%
72,3%
80,7%
91,2%
ɭɫɬɨɣɱɢɜ
31,2%
47,2%
31,8%
96,2%
-
Ɍɚɛɥɢɰɚ 2
Ɋɟɡɭɥɶɬɚɬɵɩɪɢɦɟɧɟɧɢɹɚɧɬɢɛɢɨɬɢɤɨɜɩɪɢɤɨɧɫɟɪɜɚɬɢɜɧɨɦɥɟɱɟɧɢɢ
Ȼɨɥɶɧɵɟ
Ɋɨɠɢɫɬɨɟɜɨɫɩɚɥɟɧɢɟɜɚɧɚɦɧɟɡɟ
Ɋɟɰɢɞɢɜ ɪɨɠɢɫɬɨɝɨ ɜɨɫɩɚɥɟɧɢɹ ɜ ɩɟɪɢɨɞ
ɦɟɠɞɭɫɬɚɰ. ɥɟɱɟɧɢɟɦ
ɋɪɨɤɢɡɚɠɢɜɥɟɧɢɹ
ɉɨɥɭɱɚɥɢ
ɚɧɬɢɛɢɨɬɢɤɢ
24
18
10
ɇɟɩɨɥɭɱɚɥɢ
ɚɧɬɢɛɢɨɬɢɤɢ
23
19
18*
50
60**
2
ɉɪɢɦɟɱɚɧɢɟ *F 1.10 ɪ=0.2
**F2 0.2 ɪ=0.5
ɜɟɧɢɟɭ 20,6%, ɡɧɚɱɢɬɟɥɶɧɨɟɭɦɟɧɶɲɟɧɢɟɭ
50,1% ɢ ɧɟɡɧɚɱɢɬɟɥɶɧɵɟ ɢɡɦɟɧɟɧɢɹ ɭ
29,3%;
- ɥɢɩɨɞɟɪɦɚɬɨɫɤɥɟɪɨɡ ɞɨ ɨɩɟɪɚɰɢɢ
ɜɵɹɜɥɟɧɭ 41,8%, ɚɩɨɫɥɟ – ɢɫɱɟɡɧɨɜɟɧɢɟ
ɨɬɦɟɬɢɥɢ 19,5%, ɪɟɡɤɨɟɭɦɟɧɶɲɟɧɢɟɧɚɛɥɸɞɚɥɨɫɶɭ 41,4%, ɭ 39,1% ɩɪɨɹɜɥɟɧɢɹɨɫɬɚɥɢɫɶɛɟɡɢɡɦɟɧɟɧɢɣ;
- ɭ 52% ɛɨɥɶɧɵɯɞɨɨɩɟɪɚɰɢɢɛɵɥɢɹɡɜɟɧɧɵɟ ɞɟɮɟɤɬɵ, ɩɨɫɥɟ ɥɟɱɟɧɢɹ ɭ 58,8%
ɹɡɜɵɡɚɠɢɥɢɩɨɥɧɨɫɬɶɸ, ɭ 21,5% ɤɨɥɢɱɟɫɬɜɨɹɡɜɫɨɤɪɚɬɢɥɨɫɶɥɢɛɨɭɦɟɧɶɲɢɥɚɫɶɢɯ
ɩɥɨɳɚɞɶɢɬɨɥɶɤɨ 19,6% ɨɬɦɟɬɢɥɢɧɟɡɧɚɱɢɬɟɥɶɧɵɣɷɮɮɟɤɬ.
ȼɫɟɦ ɛɨɥɶɧɵɦ ɜɵɩɨɥɧɹɥɫɹ ɩɨɫɟɜ ɫɨ
ɞɧɚ ɹɡɜɟɧɧɨɝɨ ɞɟɮɟɤɬɚ ɧɚ ɦɢɤɪɨɮɥɨɪɭ ɢ
ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ ɤ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɵɦ
ɩɪɟɩɚɪɚɬɚɦ. ɉɨɞɚɧɧɵɦɦɢɤɪɨɛɢɨɥɨɝɢɱɟɫɤɨɝɨɢɫɫɥɟɞɨɜɚɧɢɹ, ɡɨɥɨɬɢɫɬɵɣɫɬɚɮɢɥɨɤɨɤɤ
84
ɜɫɬɪɟɱɚɥɫɹɭ 163 (87,3%) ɩɚɰɢɟɧɬɨɜ, ɫɬɪɟɩɬɨɤɨɤɤ ɭ 65 (34,6%) ɛɨɥɶɧɵɯ. Ⱦɪɭɝɢɟɦɢɤɪɨɨɪɝɚɧɢɡɦɵ, ɬɚɤɢɟ, ɤɚɤ ɫɢɧɟɝɧɨɣɧɚɹɩɚɥɨɱɤɚɢɩɪɨɬɟɣ, ɜɵɞɟɥɹɥɢɫɶɪɟɞɤɨ (ɞɨ 1,6
%). Ɍɚɤɢɦɨɛɪɚɡɨɦ, ɨɫɧɨɜɧɨɣɰɟɥɶɸɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɢ ɹɜɥɹɟɬɫɹ ɷɥɢɦɢɧɚɰɢɹ ɡɨɥɨɬɢɫɬɨɝɨ ɫɬɚɮɢɥɨɤɨɤɤɚ ɢ ɫɬɪɟɩɬɨɤɨɤɤɚ
ɪ<0,01). Ɋɟɡɭɥɶɬɚɬɵɢɫɫɥɟɞɨɜɚɧɢɹɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɢɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜɤɚɧɬɢɛɢɨɬɢɤɚɦɩɪɟɞɫɬɚɜɥɟɧɵɜɬɚɛɥɢɰɟ 1.
Ȼɨɥɶɧɵɯ, ɤɨɬɨɪɵɦɛɵɥɨɨɬɤɚɡɚɧɨɜɩɪɨɜɟɞɟɧɢɢ ɨɩɟɪɚɰɢɢ (49-26%), ɥɟɱɢɥɢ ɤɨɧɫɟɪɜɚɬɢɜɧɨ. Ʉɨɧɫɟɪɜɚɬɢɜɧɨɟ ɥɟɱɟɧɢɟ
ɜɤɥɸɱɚɥɨɤɨɦɩɪɟɫɫɢɨɧɧɭɸɬɟɪɚɩɢɸ, ɩɪɟɩɚɪɚɬɵ, ɭɥɭɱɲɚɸɳɢɟɦɢɤɪɨɰɢɪɤɭɥɹɰɢɸɢ
ɪɟɨɥɨɝɢɱɟɫɤɢɟɫɜɨɣɫɬɜɚɤɪɨɜɢ, ɚɬɚɤɠɟɥɚɡɟɪɨɬɟɪɚɩɢɸ. 24 ɢɡɧɢɯɩɨɥɭɱɚɥɢɚɧɬɢɛɢɨɬɢɤɢɲɢɪɨɤɨɝɨɫɩɟɤɬɪɚɞɟɣɫɬɜɢɹ, 23 – ɧɟ
ɩɨɥɭɱɚɥɢ. ȼɨɫɬɚɥɶɧɨɦɥɟɱɟɧɢɟɛɵɥɨɢɞɟɧ-
ʋ4x2007 iɬɨɦ 15
ɬɢɱɧɵɦ. Ɋɟɡɭɥɶɬɚɬɵɨɬɪɚɠɟɧɵɜɬɚɛɥɢɰɟ 2.
ɋɪɨɤɢɡɚɠɢɜɥɟɧɢɹɹɡɜɭɩɚɰɢɟɧɬɨɜɩɨɫɥɟ
ɨɩɟɪɚɬɢɜɧɨɝɨ ɥɟɱɟɧɢɹ ɫɨɫɬɚɜɢɥɢ 12±1,2
ɧɟɞɟɥɢ, ɚɭɛɨɥɶɧɵɯ, ɤɨɬɨɪɵɦɩɪɨɜɨɞɢɥɚɫɶ
ɤɨɧɫɟɪɜɚɬɢɜɧɚɹɬɟɪɚɩɢɹ, ɫɨɫɬɚɜɢɥɢ 60±1,1
ɧɟɞɟɥɢ (ɪ<0,001).
ȼɵɜɨɞɵ
1. ɇɚɢɛɨɥɟɟɪɚɫɩɪɨɫɬɪɚɧɟɧɧɨɣɦɢɤɪɨɮɥɨɪɨɣɬɪɨɮɢɱɟɫɤɢɯɹɡɜɹɜɥɹɸɬɫɹɡɨɥɨɬɢɫɬɵɣɫɬɚɮɢɥɨɤɨɤɤ - 87,3% ɢɫɬɪɟɩɬɨɤɨɤɤ 34,6%.
2. ɉɪɢɧɟɜɨɡɦɨɠɧɨɫɬɢɩɪɨɜɟɞɟɧɢɹɬɟɫɬɚɧɚɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶɦɢɤɪɨɮɥɨɪɵɤɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɵɦ ɩɪɟɩɚɪɚɬɚɦ ɧɚɢɛɨɥɟɟ
ɷɮɮɟɤɬɢɜɧɨɢɫɩɨɥɶɡɨɜɚɬɶɜ ɥɟɱɟɧɢɢɤɥɢɧɞɚɦɢɰɢɧ, ɰɢɩɪɨɛɚɣɢɥɢɥɢɧɤɨɦɢɰɢɧ.
3. ɉɪɢɦɟɧɟɧɢɟɩɪɨɮɢɥɚɤɬɢɱɟɫɤɨɣɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɢ ɩɪɢ ɧɚɥɢɱɢɢ ɷɩɢɡɨɞɨɜ
ɪɨɠɢɫɬɨɝɨɜɨɫɩɚɥɟɧɢɹɜɚɧɚɦɧɟɡɟɫɧɢɠɚɟɬɱɚɫɬɨɬɭɪɟɰɢɞɢɜɨɜ.
4. Ɉɩɟɪɚɬɢɜɧɚɹ ɤɨɪɪɟɤɰɢɹ ɝɪɚɞɢɟɧɬɚ
ɞɚɜɥɟɧɢɹɩɨɡɜɨɥɹɟɬɡɧɚɱɢɬɟɥɶɧɨ (ɜɩɹɬɶɪɚɡ)
ɫɨɤɪɚɬɢɬɶɫɪɨɤɢɡɚɠɢɜɥɟɧɢɹɹɡɜɵ.
ɅɂɌȿɊȺɌɍɊȺ
1. ȼɜɟɞɟɧɫɤɢɣ, Ⱥ. ɇ. ȼɚɪɢɤɨɡɧɚɹɛɨɥɟɡɧɶ / Ⱥ. ɇ. ȼɜɟɞɟɧɫɤɢɣ. – Ʌ.: Ɇɟɞɢɰɢɧɚ,1983. – 208 ɫ.
2. Ƚɪɢɲɢɧ, ɂ. ɇ. ȼɚɪɢɤɨɡɢɜɚɪɢɤɨɡɧɚɹɛɨɥɟɡɧɶɧɢɠɧɢɯɤɨɧɟɱɧɨɫɬɟɣ / ɂ. ɇ. Ƚɪɢɲɢɧ, ȼ. ɇ. ɉɨɞɝɚɣɫɤɢɣ,
ɂ. ɋ. ɋɬɚɪɨɫɜɟɬɫɤɚɹ. – Ɇɧ.: ȼɵɲ. ɲɤɨɥɚ, 2005. – 253 ɫ.
3. ɂɜɚɧɨɜ, ȿ. ȼ. Ⱥɥɝɨɪɢɬɦɵɚɦɛɭɥɚɬɨɪɧɨɣɞɢɚɝɧɨɫɬɢɤɢɢɥɟɱɟɧɢɹɨɫɥɨɠɧɟɧɧɵɯɮɨɪɦɏȼɇ: ɦɟɬɨɞɢɱɟɫɤɢɟ ɪɟɤɨɦɟɧɞɚɰɢɢ / ȿ. ȼ. ɂɜɚɧɨɜ. – Ɍɸɦɟɧɶ,
2006. – 24 ɫ.
4. ɉɨɤɪɨɜɫɤɢɣ, Ⱥ. ȼ. Ʉɥɢɧɢɱɟɫɤɚɹɚɧɝɢɨɥɨɝɢɹ: ɪɭɤɨɜɨɞɫɬɜɨ: ɜ 2 ɬ. / Ⱥ. ȼ. ɉɨɤɪɨɜɫɤɢɣ; ɩɨɞɪɟɞ. Ⱥ. ȼ. ɉɨɤɪɨɜɫɤɨɝɨ. – Ɇ.: Ɇɟɞɢɰɢɧɚ, 2004. – Ɍ. 2. – 888 ɫ.
5. ɉɪɢɦɟɧɟɧɢɟ ɦɧɨɝɨɞɧɟɜɧɨɝɨ ɤɨɦɩɪɟɫɫɢɨɧɧɨɝɨ
ɜɨɡɞɟɣɫɬɜɢɹɜɤɨɦɩɥɟɤɫɧɨɦɥɟɱɟɧɢɢɜɟɧɨɡɧɵɯɬɪɨɮɢɱɟɫɤɢɯɹɡɜ / ɇ. Ⱥ. Ʉɭɡɧɟɰɨɜ [ɢɞɪ.] // Ɏɥɟɛɨɥɢɦɮɨɥɨɝɢɹ. Cɩɟɰ. ɜɵɩɭɫɤ: ɬɪɭɞɵ VI ɤɨɧɮɟɪɟɧɰɢɢȺɫɫɨɰɢɚɰɢɢɮɥɟɛɨɥɨɝɨɜɊɨɫɫɢɢ. – 2006. – ɋ. 101-102.
6. ɋɚɛɟɥɶɧɢɤɨɜ, ȼ. ȼ. ȼɚɪɢɤɨɡɧɚɹɛɨɥɟɡɧɶɧɢɠɧɢɯ
ɤɨɧɟɱɧɨɫɬɟɣ. ɋɨɜɪɟɦɟɧɧɵɣ ɜɡɝɥɹɞ ɧɚ ɩɪɨɛɥɟɦɭ /
ȼ. ȼ. ɋɚɛɟɥɶɧɢɤɨɜ, ȿ. Ʉ. ɒɭɥɟɩɨɜɚ // ɆɢɪɆɟɞɢɰɢɧɵ – 2001. – ʋ3. – ɋ. 39-41.
7. Ɏɥɟɛɨɥɨɝɢɹ: ɪɭɤɨɜɨɞɫɬɜɨɞɥɹɜɪɚɱɟɣ / ȼ. ɋ. ɋɚɜɟɥɶɟɜ [ɢɞɪ.]; ɩɨɞɪɟɞ. ȼ. ɋ. ɋɚɜɟɥɶɟɜɚ. – Ɇ.: Ɇɟɞɢɰɢɧɚ, 2001. – 664 ɫ.
8. ɏɚɧɟɜɢɱ, Ɇ. Ⱦ. Ɉɫɥɨɠɧɟɧɧɵɟɮɨɪɦɵɯɪɨɧɢɱɟɫɤɨɣɜɟɧɨɡɧɨɣɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢɧɢɠɧɢɯɤɨɧɟɱɧɨɫɬɟɣ
/ Ɇ. Ⱦ. ɏɚɧɟɜɢɱ, ȼ. ɂ. ɏɪɭɩɤɢɧ. – Ɇ.: Ɇɟɞɗɤɫɩɟɪɬɉɪɟɫɫ, 2003. – 176 ɫ.
9. Coagulation and fibrinolysis in chronic venous
insufficiency / L. Blomberg [et al.] //
Vasa. – 2001. – Vol. 30, N 3. – P. 184-187.
10. Haanson, P. O Recurrent venous thromboembolism
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11. Need for long-term anticoagulant treatment of
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ɉɨɫɬɭɩɢɥɚ 04.07.2007ɝ.
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